Anna Verri

Stress and chronic headache

Abstract The aims of this study were to assess how stress affects chronic headaches, and in particular to determine whether events play a role in the transformation of an episodic headache into a chronic form. A population of 267 Italian patients with chronic headache (headache present on average more than 15 days per month) was studied. Our results confirm a triggering role of stress on headache. We also found that episodic headache (migraine in most patients, 74.1%) preceded the development of a chronic form in about 90% cases. Among these patients, in 44.8% a stressful event correlated with the transformation. Analysis of these events revealed that minor events played a greater role than major life events, suggesting that patients with transformed headache are characterised by a different way of reacting to stress.

The importance of anxiety and depression as factors in chronicization of primary headaches

Abstract A multicenter study was carried out in 10 Italian headache centers to investigate the prevalence of anxiety and depression in patients with chronic daily headache(CDH). The study investigated 219 patients (171 F; 48 M) including 53 cases of chronic tension-type headache (CTTH), 99 cases of CTTH+ migraine and 67 cases of transformed migraine (TM). The type of headache diagnosed at the beginning was episodic tension-type headache (ETTH, n=32), ETTH + migraine (n=2), CDH ab initio (n=22), migraine with/without aura (n=151), not classifiable migraine (n=7) and not classifiable headache (n=3). The assessment of anxiety and depression was carried out using a Zung self-rating scale for anxiety (Zung A) and for depression (Zung D). The results show that anxiety and depression levels, in each group, were related to sex (F>M). Anxiety, but not depression, was related to the length of chronicization process. Anxiety and depression did not correlate with type of headache at onset, with ongoing headache or, surprisingly, with the abuse of anti-inflammatory drugs. These data suggest the chronicization is a biological and psychological trait.

Eating disorders and their correlates in high school adolescents of Northern Italy.

OBJECTIVE The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. METHODS The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2 +/- 1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. RESULTS Females scored significantly higher than males at ISED (13.4 +/- 7.7 vs. 7.6 +/- 5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. CONCLUSIONS Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.

Psychiatric disorders in chronic daily headache: detection by means of the SCID interview

Abstract The identification of possible individual or/and environmental factors responsible for the chronic evolution of headache has represented a critical issue in recent years. The goal of this research was to enroll adult chronic daily headache (CDH) sufferers and to seek for psychiatric disorders, as possible transformation factor, by means of a complex neuropsychological investigation. The psychiatric evaluation was performed using the Structured Clinical Interview (SCID), according to the DSM-IV diagnostic criteria. The overall prevalence of psychiatric disorders according to DSM-IV criteria was 66.1%. No statistical difference was found in psychiatric comorbidity according to gender (women, 68.9% men, 52,4%). The prevalence of psychiatric disorders was 69.7% in drug abusers (classified in accordance with clinical interview) and 57.1% in non-abusers (the difference was not statistically significant). Comparing the three subtypes of CDH, a psychiatric disorder was found in 50% of chronic tension-type headache patients, in 72.2% of those with chronic coexisting migraine and tension-type headache(CT vs. CCMT-TH, p<0.01) and in 70.3% of patients with chronic migraine.

Quality of life and illness behaviour in chronic daily headache patients

Abstract Chronic pathologies, above all those in which is present pain, can induce a considerable impairment in quality of life. The concept of illness behaviour is closely related to that of quality of life. It can be defined as the way to estimate and to react to ones own health status. In this study on chronic headache patients, the sickness impact profile (SIP) was used as a measure of illness-related quality of life. The way of experiencing the disease was moreover quantified by means of the illness behaviour questionnaire (IBQ). Patients with chronic headache showed a remarkable impairment in most of their daily activities. At the same time, they lived their illnesses poorly. The longer was chronic headache duration, the more disability was marked. Fermale gender was associated with a more severe profile, both in SIP and in IBQ.

Cl/HCO3 Antiport Affects H-Lactate Symport Activity at the Basolateral Pole of Jejunum Enterocyte

Background/Aims: Under normal conditions the jejunal tract of the rat intestine absorbs HCO3. A basolateral Cl/HCO3 exchange, evidenced by means of membrane vesicles, could be involved in this process. Aim of this study was to investigate the anion exchange activity in the whole jejunal tract, where various transport systems could interact. Methods: In the jejunal tract of rat intestine everted and incubated in vitro, the experimental conditions set up minimized loss of CO2 from the serosal solution, where pH and pCO2 were determined together with fluid and electrolyte transintestinal transport. Results: The serosal pCO2 increase and pH decrease, evident during the experiment, could be antagonized by enhancing the 4,4-diisothiocyanatostilbene-2,2′-disulfonic acid (DIDS) concentrations in the serosal fluid. Moreover high DIDS concentration affected fluid, sodium, lactate, bicarbonate and, although in the opposite direction, chloride transport, whilst they were ineffective on K flux. Conclusion: These results give evidence that in the basolateral membrane the inhibition of Cl/HCO3 antiport causes a diminution of lactic acid movement. Therefore we can hypothesize that Cl/HCO3 antiport facilitates basolateral H-lactate symport in order to carry endogenous lactic acid towards the blood stream.

Chronic daily headache: a Rorschach study

Abstract The aim of this study was to describe the distinctive personality traits and their interest to the development of a chronic form of headache, by means of the Rorschach test, a projective approach, in an automated version compiled by a trained system (PRALP3). This study did not show the existence of a pathological structure in the chronic headache sufferer personality (in the psychiatric sense of the word). The most important finding is the admission that both neurosis associated with anxious-depressive elements and inhibited emotional overflowing are important factors in the genesis of chronic daily headache. This study does not exclude that other factors different from personality traits may also play a pathogenetic role in headache worsening. In other words, the development of chronic daily headache may be a patterned or learned response generated by the brain in relation to multiple inciting causes (stress, drug abuse) or individual predisposition (personality traits).